Political Roundtable - Part V

[noworriesinmd]

On second thought, the best comparison might be the European Union, but...each member country has their own insurance policies. I wonder if that will every change? My bet is no.

[barelyawake]

A) This whole argument that Americans spend more on healthcare because they are less healthy with their habits has been debunked. See the video I posted earlier. Americans smoke much less than other countries with greater health.

B) Extending life will suddenly become unprofitable? What's the greatest fear in human existence? People will spend (even in a system where their insurance doesn't cover it) to avoid death. There will always be money there.

C) We waste most of our money on the last few months of life. For a "Christian nation," we certainly never want to meet God. Perhaps what we need is a morality change over assisted suicide, and more honest reckoning with what it means to be human and alive.

[Severn Hoos]

How is India's and China's healthcare systems?

Don't know. Is this even a meaningful comparison given that China and India are still developing in many ways?

And therein lies the point. China and India are "developing" today in large part because they have only recently embraced markets over planning. So despite immense natural and human resource advantages, they were "underdeveloped".

In my opinion, increased government involvement in any area of the market - beyond the basic role of "referee", which is to say, enforcing laws and ensuring access for consumers and producers - is moving away from the direction of economic freedom. And I also believe that most of the advances in human existence, especially in the past 3 centuries or so, are thanks to economic freedom.

And this is not only in economic terms. Look at issues from health to pollution to longevity, and so forth. Map out positive indicators compared to economic freedom and the results are compelling. So it's not about "I got mine, don't take it away from me!" as much as it is - "This is a way to get more for everyone." And I believe that applies in Healthcare also.

Unfortunately, there is no experiment to conduct, or control scenario to compare to when making changes like this. So, after single-payer goes into effect, it will be viewed as a success. But that won't show the cure for cancer that might have been discovered, or the advancements in technology that could have been. Clearly, I can't prove they will (or would) happen, but the unseen things that didn't happen because of a policy change are never included in the evaluation of that policy, for the obvious reason that they never happened.

[noworriesinmd]

Nivek, here you go. I could not find an article quickly, but this should be properly commented because it is a research paper.

Look at II-D

http://www-bcf.usc.edu/~idjlaw/PDF/15-2/15-2%20Ma.pdf


HuffPost rant
http://www.huffingtonpost.com/hava-volt ... 99339.html

[noworriesinmd]

A) This whole argument that Americans spend more on healthcare because they are less healthy with their habits has been debunked. See the video I posted earlier. Americans smoke much less than other countries with greater health.

B) Extending life will suddenly become unprofitable? What's the greatest fear in human existence? People will spend (even in a system where their insurance doesn't cover it) to avoid death. There will always be money there.

C) We waste most of our money on the last few months of life. For a "Christian nation," we certainly never want to meet God. Perhaps what we need is a morality change over assisted suicide, and more honest reckoning with what it means to be human and alive.

I'll take your word for it. You are right, end of life care is the costliest. The reason why I made those comments, is that most of the costliest care is preventable.

[dckingsfan]

I understand that single payer wouldn't have passed. I'm just saying that it seems pretty obvious to me that the simplest, most workable, realistic solution to providing healthcare for everyone while getting a handle on escalating costs would be a single-payer system. I think "what works" ought to trump ideology. Which I know would definitely be a minority position if I was on Capitol Hill.

Eventually, single payer will happen.

When you take away the noise and the rhetoric, I think the singular question about healthcare comes down to this statement: "the simplest, most workable, realistic solution to providing healthcare for everyone while getting a handle on escalating costs would be a single-payer system."

I could agree with this - if the goal is only to provide the current level of Healthcare services and technology to the maximum number of people.

But the problem is that it assumes a zero-sum game based on today's status quo. What it doesn't account for is the unseen (see Bastiat). It doesn't account for the reduced incentives for younger people to go into medicine. Which in turn would mean fewer Doctors, Nurses, etc. For a time, we can continue "importing" medical professionals from other countries, but even that trend would eventually dissipate.

It doesn't account for the reduced incentives for medical supply companies to stay in business, or for new companies to enter the market. With fewer providers, you get what limited competition always brings - less quality, higher prices, and in the end, monopolies.

It doesn't account for the reduced incentive for cutting edge technology companies to develop new means of treating and preventing diseases. This is the most pernicious part, IMO, because the cure that is not developed is never seen, and thus never missed. Without advancement, we would be locked into today's technology - impressive, to say the least, but could be so much more advanced if not stifled.

I don't oppose single payer / increased governmental involvement because I hate poor people, or because the President doesn't look like me, or for any of the other reasons that are typically ascribed to those like me who tend to support maximizing freedom, especially economic freedom. I oppose such measures because I believe that they will reduce the likelihood that the next breakthrough will be discovered. And because I believe that allowing the incentives which drive not only technological advancements, but the career choices of those who would go into medicine, to work their "magic" will deliver greater benefit to the maximum number of people.

The biggest losers of all this will be the (single payer) overseas users of healthcare - we routinely produce a large share of the medical advances and technology that are then cloned and produced very inexpensively for their single payer systems overseas.

There will still be companies that produce the technology, just not as many $$s will chase the technology breakthroughs.

We are already seeing a large drop in those going into medicine (and even many of those can't find the residency training programs they need to practice). So yes, that is going to create a shortage - this will just speed up that shortage.

But to get us out of the near-term hole that we have dug, I don't see a better political way. What I see happening is premium health care coverage for the top 5% and increased health care for the bottom 20%.

[dckingsfan]

My issues with ACA
1. No one wants to tell you the truth. Three parties determine the cost: You, Your Healthcare Provider, AND the company/person/organization paying for it.

2. We have a procedure driven medical culture. I've dated many a doctor finishing their residency and like it or not, they all want to get paid. You did not "waste" your life until 30 to get paid 50k a year.

3. Politicians will never tell you the truth. Obama openly lied to the American people about ACA, when he made the keep your insurance comment..and he knew he was lying. Republican's will do nothing to help this program. Imagine if this become our Rowe vs. Wade. After decades..that still is not decided some people's mind

4. Politician's will always overspend and over promise. It is their job to make as many people as possible happy. That is why difficult decisions can't be made. If you piss off your constituents then you loose your job. 99% hate congress, but 99% LOVE their elected representative.

5. American's don't want to hear the truth...we all sadly cost something. Few people are worth 20M to fix. We all believe (Myself included), that it is ok to spend 100M to fix an issue. We are fat/lazy slobs and we expect docs to put us back together after we neglect and abuse our bodies for years.

People love medicare because they don't know the true cost of getting healthcare. The programs enriches medical professionals and obscures the true cost from the customer. $20 covers everything. Politicians would never force people to pay $200 per visit (if that was the true cost) because Seniors are on fixed income and VOTE.

6. Young people are getting screwed. A tax credit is different than a subsidy. I could be wrong, but how I'm reading the law....you pay 500+ dollars a month (money you don't have), then you get a refund on April 15th. Anyone who takes that deal is dumb.

Healthcare is broken and should be fixed. However, crazy deals made at night to gain a few votes and a bill that is HUGE and unreadable shows how blinded people are based on their political views.

The website rollout is a joke. 3 1/2 years to do this would have gotten any executive fired in the private sector, but instead we are getting "spin". Bugs are allowed, but the site just does not work. I would not be surprised if it uses cold fusion....which still is an approved gov't IT technology.

RANT OVER>

Really nice rant though...

[dckingsfan]

As for research, I work at NIH. I'm all for it. I expect it will continue. Generally speaking and historically, it's been politically popular. And successful research will continue to be rewarded by market success.

A couple of points. First, If entitlement costs continue to rise then won't we have less $$s for research? I know, this one is a little off-topic. But I think we are seeing through the sequester that it is a bit of a zero sum game. I could definitely see research slashed 20-30 percent moving forward. I am also a HUGE fan of research, so I find this a bit disconcerting. I think that politically the left will defend entitlements to the death and the right will defend military spending.

Second, if you believe business folks invest their $$s into areas where they think they will get the largest multiples back on their investment, don't you think that they will scale back their investments to some degree? This is a bit rhetorical because we have already seen it from all but one of the big pharmaceuticals... I guess being in the business you already know that.

Last, if you believe that the government will keep punishing the private sector with lawsuits (and Obamacare gives them leverage to bring those lawsuits) - don't you think that is going to make private institutions wary of rolling out products here in the US?

[dckingsfan]

Nivek, here you go. I could not find an article quickly, but this should be properly commented because it is a research paper.

Look at II-D

http://www-bcf.usc.edu/~idjlaw/PDF/15-2/15-2%20Ma.pdf


HuffPost rant
http://www.huffingtonpost.com/hava-volt ... 99339.html

Thing one - 11% of revenues toward research is pretty decent.

Thing two - Cost of advertising/sales as percentage of revenue is reasonable.

Thing three - agreed with Huffington Post article - and cost for drugs oversees will start to climb if we drop the cost of drugs here - and I am all for that. But remember = 10% of revenue against R&D in a modern "cash cow" corporation is pretty reasonable. So, as that number drops, there is less for research - just saying that is the unintended consequence.

[W. Unseld]

Centralized planning obviously has some merit but at a small dose it's an anti-dote and at a high dose it can be a poison. There is probably no point in arguing for or against single payer while ACA is still going but I like for my decision makers to be as unbureautic and as available to me as possible. If the ACA is any indication many decisions will be top down.
If my health insurance refuses to pay for something I can go through their lame faux appeals process and then eventually take it to court to be heard from by a neutral government official (judge) where I actually have a shot. If the government is my only option they will also be the judge, there will be no neutral, disinterested third party for me to go complain to.
Why not just regulate the existing insurance companies and pay subsidies for those who can't afford it? That way if Optima covers things that are important to me then I can pick them but Sally might choose Anthem b/c their coverage is more geared toward her needs. There are multiple options and the government can maintain neutrality in resolving disputes. If anyone disagrees with me that this is a factor, I invite them to file suit in the city or county they live in against the city or county they live in.

**Edit--I've also never understood why things can't be tried by a state or a hanful of states. If it works, whatever state wants to can adopt it. If it needs tweaking the next state can tweak it. If your state just won't do it, you can move to a state that will. But if it doesn't work and everyone has to do it you're screwed and there is no going back. By contrast if it doesn't work for a few states other states can try different things and adopt different approaches.

[Wizardspride]

I came across this and I echo these sentiments.


Van Jones: Let's Stop Trying to Please Republicans


Van Jones: I don't understand how this individual mandate is something that we've allowed the Republicans to define as some sort of, quote-unquote, government takeover. In fact, it's their idea. The progressives were saying we want single-payer. Myself, I would say why do you need insurance companies for health care at all. Insurance is what you buy when you don't know if something bad is going to happen. Maybe I'll crash my car. Maybe I won't. I don't know. So I'm going to get car insurance just in case. Everybody's going to get sick and die, so you know every single person's going to need health insurance. That's not something you can provide insurance for, that's called a service.

So my view, single-payer. The Republicans always said, no, that's too much government. So we came back and said, okay, no single-payer. How about a public option? So you'd a public program, everybody could join Medicare or compete with the private companies, too much government. We want individual responsibility. So we said, fine, you win. We'll do it your way, individual mandate. And then, they say that is a socialist government takeover. Well, hold on a second now. You're now a part of the pro-moocher caucus? You're saying it's okay for people to just dive bomb their way into the emergency room? Yeah, don't worry about it. Don't get any insurance. The government will pay for it. Now, you're like the pro-freeloader party?

This Republican Party, from my point of view, has taken the posture that any idea, even their own ideas, if they're championed by this president, they will oppose. And I think that discredits them. It's like chasing a bunny on the old dog track. They have a mechanical bunny. If you've ever been to a dog track, I'm from Tennessee, if you ever go to Memphis, they have a dog track and they have a mechanical bunny. And they open the gates and the dogs just go and try and chase that mechanical bunny. And I think those dogs probably think someday they're going to catch that bunny. They're never going to catch that bunny because the bunny keeps moving.

You're trying to chase the right to try to convince them to agree with you. They will run away from their own ideas if they think a Democrat embraces them. It was a Republican idea to have cap and trade, a market-based, business-friendly solution for carbon and climate problems. That was the Heritage Foundation that came up with cap and trade. We were saying carbon tax. To chase them, we moved to cap and trade and they moved on to don't do anything. Climate change isn't even real.

On health care, it was their idea to have an individual mandate and personal responsibility and don't have a big government single-payer system. We moved from single-payer through public option to individual mandate trying to catch them and now they say that the individual mandate is socialism. You will never catch this bunny. You will never, so what you need to do is stand for what you believe in and bring a majority around your own ideas and govern. And it's the biggest fallacy on the part of liberals is that that little hound dog running around that track is ever going to catch that bunny and that we will ever be able to compromise enough to appease the right wing in this country so they'll actually govern with us in a responsible way. They have to be defeated at the ballot box by a stable governing majority that can implement the changes that we need in this country, whether they want to participate or not.

[dckingsfan]

Hey Wizardspride, I think that Van Jones has a flaw in his argument. I don't think that you can say "Republicans" did this or did that. Nor can you say "Democrats" did this or did that.

I think the key is some Republicans were against certain aspects and others were against other aspects. I think the same could be said about the Democrats as well. Add them all up and there wasn't any consensus.

Example: The individual mandates were endorsed by certain parts of the Republican party and opposed by other parts of the Republican party. Does that mean all republicans were against individual mandates?

It is like saying all Democrats are against entitlement reform - we know that isn't true.

[Wizardspride]

Hey Wizardspride, I think that Van Jones has a flaw in his argument. I don't think that you can say "Republicans" did this or did that. Nor can you say "Democrats" did this or did that.

I think the key is some Republicans were against certain aspects and others were against other aspects. I think the same could be said about the Democrats as well. Add them all up and there wasn't any consensus.

Example: The individual mandates were endorsed by certain parts of the Republican party and opposed by other parts of the Republican party. Does that mean all republicans were against individual mandates?

It is like saying all Democrats are against entitlement reform - we know that isn't true.

Yeah, but what blows that argument out of the water is the fact that many of the SAME REPUBLICANS who championed the individual mandate now oppose it.

I'm not referring to the party in general. I'm talking about specific members. Prominent members.

Honestly, if you do some research you'll be surprised at how much of "Obama's Marxist agenda" was taken straight from the GOP playbook.

That's what angers me so much.

[noworriesinmd]

I'm not arguing for/against ACA

Van Jones arguing that a past idea is good now is stupid.

That is like arguing that slavery was some idiot's good idea in the past and that same idea is brilliant now (sarcasm).

Learning from someone in AA that drugs/alcohol got them through some trauma...and you should do the same because some person had that "genius" idea in the past.

Just because you think of something a few years ago doesn't make it a good idea today.

I'm not arguing for/against ACA, but Van Jones' argument is a very stupid argument that I hate hearing.

It's ok to change your mind. Hmmm...didn't the President say he was against Gay Marriage in the beginning of his term?

[Wizardspride]

I'm not arguing for/against ACA

Van Jones arguing that a past idea is good now is stupid.

That is like arguing that slavery was some idiot's good idea in the past and that same idea is brilliant now (sarcasm).

Learning from someone in AA that drugs/alcohol got them through some trauma...and you should do the same because some person had that "genius" idea in the past.

Just because you think of something a few years ago doesn't make it a good idea today.

I'm not arguing for/against ACA, but Van Jones' argument is a very stupid argument that I hate hearing.

It's ok to change your mind. Hmmm...didn't the President say he was against Gay Marriage in the beginning of his term?

In principle you're right....but in this case I highly doubt these guys suddenly had an epiphany about the individual mandate etc. once President Obama took office.

[dckingsfan]

Hey Wizardspride, I think that Van Jones has a flaw in his argument. I don't think that you can say "Republicans" did this or did that. Nor can you say "Democrats" did this or did that.

I think the key is some Republicans were against certain aspects and others were against other aspects. I think the same could be said about the Democrats as well. Add them all up and there wasn't any consensus.

Example: The individual mandates were endorsed by certain parts of the Republican party and opposed by other parts of the Republican party. Does that mean all republicans were against individual mandates?

It is like saying all Democrats are against entitlement reform - we know that isn't true.

Yeah, but what blows that argument out of the water is the fact that many of the SAME REPUBLICANS who championed the individual mandate now oppose it.

I'm not referring to the party in general. I'm talking about specific members. Prominent members.

Honestly, if you do some research you'll be surprised at how much of "Obama's Marxist agenda" was taken straight from the GOP playbook.

That's what angers me so much.

You make a good point... but also remember that most of the members of both parties have had multiple stances on heathcare. And much of that is due to a lack of understanding of the issue couple with the actual way laws are written.

For example, I might be for a specific agenda but against the way it is going to be implemented.

[noworriesinmd]

In principle you're right....but in this case I highly doubt these guys suddenly had an epiphany about the individual mandate etc. once President Obama took office.

The reason why I say this....is to illustrate why the system is broken. People on both sides are so tied to their beliefs that they won't entertain the fact that maybe people revisited an idea and thought it was wrong.

There are Republicans that are against everything the President wants to do without looking for compromise.

I just watched Lincoln. Funny how the same things are being done today.

After watching Lincoln:

1. I thought to myself: Does the ends justify the means? (i.e. Lincoln, bribed, lied, manipulated and bullied people into voting for the 13th amendment (opinion not on fact, but on movie). Maybe the same can be said with ACA.

2. You really need a leader with conviction leading the country. It's sad that you have to go to an Ivy league school to be President (at least I have a shot)...this fosters group think....and Lincoln would never be voted President today ("unlearned" with a bipolar wife).

[noworriesinmd]

If this article is true, then all I can say is WOW

We were being told: 4.7M unique visitors and +!M registered.

http://www.cbsnews.com/8301-18563_162-5 ... ents-show/

According to CBS 6 (not 6k, or 6M...but 6) enrolled the first day
A little over 100 the next day
and over 240 the following day.

WOW, 3 1/2 years and 70M later....wow 6.

I wish I could say something else.

[W. Unseld]

Wizpride, I hate hypocrisy as much as the next guy (but have been guilty of it--particularly when lecturing my children) but focusing on the fact that some R's wanted this before Obama pushed for it and now they don't b/c Obama is pushing for it is fine and probably worth noting and even reminding people of but now it is law so what seems to me to be more important is how it is actually effecting people.

This is from the Hill (a fairly neutral source that gets disbursed to pretty much every member of Congress):
"Lawmakers discussed a proposal by Sen. Mary Landrieu (D-La.) to let people keep their health plans, even if they fall short of the requirements set under the new law, according to another lawmaker in the room.
Landrieu expects several Democrats to co-sponsor the proposal. Sen. Joe Manchin (D-W.Va.) told reporters that he plans to sign onto Landrieu’s bill. Sen. Mark Pryor (D-Ark.), who faces a tough race next year, said he is in the midst of reviewing a draft."

I'm curious if the board would oppose allowing people who want to keep their health plan to be able to actually keep it, I'm also curious about the ramifications if this were to pass. There is also an R sponsored bill on this so I think it will have bi-partisan support. I expect party leadership and the whitehouse to exert pressure to vote against this but I expect a certain amount of dems who are up for re-election to vote for it anyway.

[dckingsfan]

In principle you're right....but in this case I highly doubt these guys suddenly had an epiphany about the individual mandate etc. once President Obama took office.

The reason why I say this....is to illustrate why the system is broken. People on both sides are so tied to their beliefs that they won't entertain the fact that maybe people revisited an idea and thought it was wrong.

There are Republicans that are against everything the President wants to do without looking for compromise.

I just watched Lincoln. Funny how the same things are being done today.

After watching Lincoln:

1. I thought to myself: Does the ends justify the means? (i.e. Lincoln, bribed, lied, manipulated and bullied people into voting for the 13th amendment (opinion not on fact, but on movie). Maybe the same can be said with ACA.

2. You really need a leader with conviction leading the country. It's sad that you have to go to an Ivy league school to be President (at least I have a shot)...this fosters group think....and Lincoln would never be voted President today ("unlearned" with a bipolar wife).

I really don't want to justify the Republican's behavior - especially after tying the ACA to budget deficits. But you could understand how some Republicans wanted to go after the economy vs. healthcare when the ACA came up. You can also understand how some Republicans would be for an ACA like law in states but not at the federal level - states rights.

And I don't think you put the ACA on the same terms as slavery, right?

Even if you are for the ACA, it is one of THE worst written laws in recent memory. It just wasn't very well done. It was brought in when we should have been taking uncertainty out of the thinking of business leaders. Couple that with the poor implementation of the stimulus bill and you have very little reason for folks in the Republican party to come to the middle.

If you are a Democrat and were party to the stimulus and the ACA you have to defend it. And going backwards on the ACA would be a disasters as well. And if you are a Democrat and believe that entitlement reform is important, you are cast as a Republican. If you are a Democrat that believes you should simplify the tax code (without major new tax revenue) you are cast as a Republican. So, there are very few reasons for Democrats to come to the middle.

Right now there is very little overlap on what either party will discuss with the other. So, expect more gridlock with where we are now. That allows the Democrats to run against the evil 1% and Republicans to run against big government and the deficits. Safe for both parties in the areas they represent.